ABSTRACT
Where does the establishment of the National Health Service (NHS) fit into the pattern of health-care development which the mode of analysis used in this book has suggested so far? We have seen that the establishment of NHI in 1911 was part of the Liberal government’s answer to social unrest. Blanpain (1978) has suggested that all the European health insurance systems arose in similar circumstances. Does this mean, as Navarro (1978) argues, that whether health provisions are made and how they are made depend on the current score in the class struggle? Does state intervention follow from the logic of biomedical knowledge and the techniques and facilities required to practise it? Does it flow from successful collective organization on the part of the medical profession, as Parry and Parry (1976) propose? Is the NHS the creature of administrators and their advisers anxious to have a rational and controllable structure to undertake what by the mid-twentieth century had come to be seen as an essential service to be provided in any advanced industrial society? Was the NHS the logical culmination of humanitarian moves based on values associated with equity and redistributive justice for which rational planning and administration were necessary (cf. Abel-Smith, 1978)? Or was it, as others suggest, while not denying the humane intentions and personal devotion of many reformers, that the Welfare State, of which the NHS is a crucial element, was developed in response to the internal contradictions of capitalism, of the need to reproduce the labour force and the need which capital shares with the state to maintain order (cf. Doyal with Pennell, 1979; Gough, 1979)? How influential were left-wing interests? Can the NHS be more simply seen as the response of democratic government to the balance of interests in a society with a plural political system (Eckstein, 1958; Klein, 1983; Willcocks, 1967)?
